The type of health care delivery system adopted by a community is determined by its size and the availability of volunteers, professionals and financial re sources. Hospice programs often must exist in environments and through regula tions not originally designed for them. The necessity to survive financially through third-party reimbursement and donations has had an impact on the breadth and depth of care delivered through many programs. Unfortunately, in some instances, Medicare patients have been forced to accept a large financial responsibility in order to receive hospice care. Because some patients are reluc tant or unable to meet these financial restrictions, they are placed in traditional care settings without adequate support and symptom management.